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Policy on Relationships With Billing Agents <br /> I. INTRODUCTION, <br /> Policy addresses general guidelines regarding the structure of billing agent agreements/contracts as <br /> well as operational considerations regarding the extent of billing agent rights and responsibilities. <br /> Such contracts shall comply with this policy. <br /> II. GENERAL STRUCTURE AND COMPENSATION ISSUES <br /> 1. provide that in receiving payment from Medicare, the agent acts only on behalf of North State <br /> Medical Transport; and <br /> 2. provide that the agent will act under strict compliance with all state and federal laws. <br /> III. OPERATIONAL ISSUES <br /> A. In addition to the general reimbursement issues discussed in Section II, billing agent <br /> agreements should address all of the following operational issues: <br /> 1. overpayments - how will overpayments be handled, what authority will the billing agent <br /> have to deal with third party payors.(Documentation, Timeline etc. <br /> 2. billing/medical records - what steps will the billing agent be required to take when a <br /> billing/medical record is incomplete and/or lacks sufficient documentation of medical <br /> necessity, who will the billing agent be required to contact and what authority will the <br /> billing agent have to fill in missing information? <br /> 3. payor contacts - when will a billing agent be peticiitted to contact a third party payor, <br /> what authority will a billing agent have in such a situation and how will the billing agent <br /> document third party payor contracts? <br /> 4. government audits - how will a billing agent be required to act during the course of a <br /> government audit, and if the agent will be following a government audit policy developed <br /> by the provider, how will the provider ensure that the agent is trained regarding the <br /> provider's policy? <br /> 5. general policies and procedures—Attestation that the billing agent maintains and adhere <br /> to compliance policies and how will compliance with these policies and requirements be <br /> ensured? <br /> 6. determinations of medical necessity - while billing agents will be without authority to determine <br /> medical necessity or to complete certificates of medical necessity, billing agents will provide <br /> routine education to customers, who will control the type of education information furnished <br /> and how will billing agents be trained in this regard? <br /> IV. LEGAL REVIEW AND RECORDKEEPING <br /> 35 <br />